Don’t treat all cases of gender dysphoria the same way

Debra Soh holds a PhD in sexual neuroscience from York University and writes about the science and politics of sex

In a list of today's top-10 contentious issues, the subject of transgender children easily covets the No. 1 spot. Parents, teachers, and medical professionals have been told that "affirming" a child who identifies as the opposite sex is the only acceptable approach. Anything short of that is transphobic and will lead a child to suicide.

But it's not as simple as what we've been led to believe. There are a number of reasons why children may want to transition and, in many cases, they don't have anything to do with feelings of being "born in the wrong body."

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For some children with gender dysphoria, the fact that they are different from their peers is apparent from the moment they are born. These children prefer to dress and behave like the opposite sex and have predominantly cross-sex friendships.

Previous research has shown that homosexuality is associated with gender-variant behaviour in childhood. All 11 studies following gender dysphoric children over time show the same finding – if they don't transition, 60 to 90 per cent desist upon reaching puberty and grow up to be gay.

For other children, they don't begin experiencing issues with their gender until adolescence, and over the last 10 years, there has been a sharp increase in the number of gender clinic referrals for adolescent girls wanting to become boys.

Rapid-onset gender dysphoria, seen primarily in teenage girls and university-aged young women, is characterized by a sudden desire to transition without any signs of gender dysphoria in childhood. It typically emerges after an individual has spent much time researching gender dysphoria online.

A 2017 study found an association between this phenomenon and having a friend (or multiple friends) identify as transgender, suggesting similarities to a social contagion. These girls frequently also have other mental-health conditions, like autism or borderline personality disorder, that should be the focus of concern instead.

In other cases, adolescent girls will desire a transition because they are sexually attracted to gay men, and gay men generally prefer partners with masculine bodies and corresponding genitalia. In this case, a whole host of important factors should be discussed; in addition to being on hormonal treatment for life, the frank reality is, surgery to construct realistic-looking male genitalia is still in the process of being refined.

Incredibly, no one is talking about any of this; instead, the conversation is quite confidently stampeding in the opposite direction. For example, the Elementary Teachers' Federation of Ontario, in its Winter 2017 magazine issue, told teachers that "gender is not binary" (which is scientifically untrue) and advised them to "not make assumptions about the gender of [their] students."

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Recent statistics estimate that six in every 1,000 adults are transgender (a number that has doubled in the last decade), and as many as one in every 100 people might have a difference of sex development (a medical condition formerly called "intersex").

Without question, these individuals deserve dignity and respect. At the same time, it isn't a far cry to assume the vast majority of children will grow up to identify as their birth sex.

Anyone who tries to speak to this knows what happens next: You get called a hateful bigot. Parents, in particular, are told that 41 per cent of transgender people have attempted suicide and their child will become part of this statistic.

However, the researchers behind that statistic acknowledged the limitations of their study; they didn't ask respondents about other mental-health conditions, nor whether they identified as transgender, at the time of their suicide attempt.

After the 2015 passing of Ontario's Bill 77 – the Affirming Sexual Orientation and Gender Identity Act – which incorrectly conflated unethical therapies aiming to change sexual orientation with those exploring gender identity, clinicians are unable to have honest conversations with parents about their children, out of fears of losing their license to practice. This has important implications for a child's well-being, because social and medical transitioning often aren't appropriate solutions.

Children presenting with gender dysphoria, whatever the reason, deserve to be treated with love and compassion. This includes adolescents for whom transitioning is deemed the best way forward, should alternative approaches be ruled out.

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But by taking children's words at face value, the adults in the room are denying them the help they need. The goal of successful policy and medical treatment should be to improve the lives of those who are struggling, not to pat ourselves on the back for being open-minded and progressive.

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